Provider Demographics
NPI:1871198168
Name:MCKAY, MICHELLE RAYLYNN
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RAYLYNN
Last Name:MCKAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 SOUTH VERMONT AVENUE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-2705
Mailing Address - Country:US
Mailing Address - Phone:323-672-1790
Mailing Address - Fax:
Practice Address - Street 1:550 SOUTH VERMONT AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-2705
Practice Address - Country:US
Practice Address - Phone:323-672-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician